This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

No abstract

Penicillium marneffei is a thermally dimorphic fungus that can cause severe opportunistic infections in endemic regions of Southeast Asia, particularly in individuals infected with human immunodeficiency virus-1, but has rarely been reported in solid organ transplant recipients. Herein, we report the first case, to our knowledge, of P. marneffei infection in a lung transplant recipient, occurring in a 41-year-old woman 28 months post lung transplantation, after recent travel to Vietnam. We have reviewed the literature to derive some management principles for this rare infection in this clinical context. The number of P. marneffei infections in transplant recipients may increase, as a result of increasing rates of transplantation and travel to endemic areas.

Background Invasive fungal infections (IFI) are common after lung transplantation with reported incidence of 8.1% to 16% at 12 months post‐transplant, and 3‐month all‐cause mortality after IFI of 21.7%. Methods We performed a retrospective study of IFI and fungal colonization in lung transplants (LTs) from November 2004 to February 2017. Results 137 LTs were followed for a median 4.1 years (IQR 2.1‐6.2 years). In addition to nebulized amphotericin for the transplant admission to all LTs, systemic mold‐active azole was given to 80/130 (61.5%) LTs in the first 6 months post‐transplant, 57/121 (47.1%) in the period 6‐12 months after transplant, and 93/124 (75%) in the period more than 12 months post‐transplant. Mold airways colonization was found in 81 (59.1%) LTs before and 110 (80.3%) LTs after transplantation. There were 13 IFIs for an overall incidence of 2.1 per 100 person‐years, occurring at a median 583 days (IQR 182‐1110 days) post‐transplant, a cumulative incidence of 3.8% at 1 year, 7.6% at 3 years and 10.1% at 5 years post‐transplant. All‐cause 3‐month mortality after IFI was 7.7%. Aspergillus species followed by Scedosporium apiospermum and Cryptococcus species were the commonest fungi causing IFI. Conclusions In our cohort the rate of IFI was comparatively low, likely because of comprehensive early antifungal use and preemptive therapy at any time after transplant. Prospective studies of fungal colonization late after LT are required to determine the risks and benefits of watchful waiting compared to preemptive therapy.

No abstract